Association Between Lymphedema Self-Care Adherence and Lymphedema Outcomes Among Women with Breast Cancer-Related Lymphedema

Abstract

Objective To determine if adherence to self-care modalities for breast cancer-related lymphedema (BCRL) predicts BCRL outcomes among 128 breast cancer (BrCa) survivors who participated in the 12-month physical activity and lymphedema (PAL) trial. Design This was a prospective cohort study. Adherence to 10 BCRL self-care modalities, as recommended in the clinical practice guidelines for the management of BCRL was assessed by questionnaire at baseline. BCRL outcomes assessed at baseline and 12-months included volumetry, circumferences, bioimpedence spectroscopy, the Norman lymphedema survey, and clinician-defined lymphedema exacerbations requiring treatment. Generalized linear models were used to estimate the relationship between adherence to BCRL self-care modalities and the likelihood of experiencing a BCRL outcome. Results Adherence to BCRL self-care activities did not predict experiencing any BCRL outcomes at 12-months. Levels of adherence to BCRL self-care modalities did not predict a ≥5% decrease in interlimb volume (Ptrend=0.79), ≥5% decrease in the sum of interlimb arm circumferences (Ptrend=0.47), ≥10% decrease in bioimpedence spectroscopy (Ptrend=0.83), ≥1 decrease in self-reported lymphedema symptoms (Ptrend=0.91), or clinician-defined lymphedema exacerbation requiring treatment (Ptrend=0.84). Conclusions Our findings suggest levels of BCRL self-care adherence do not predict BCRL outcomes among BrCa survivors with stable lymphedema who were followed for 12-months.

Race or Resource? BMI, Race, and Other Social Factors as Risk Factors for Interlimb Differences among Overweight Breast Cancer Survivors with Lymphedema

“…Low-resource women may not have what they need to navigate worsening BCRL, especially in light of other competing demands that they face in day-to-day life. Still, in line with other studies with similar populations, adherence to BCRL care did not eliminate the interlimb volume disparity [ 45 , 46 ]. This may suggest that adherence to or usage of BCRL care may not be sufficient to overcome disparities in severity.…”

“…Lymph node removal was later classified as sentinel lymph node biopsy for <5 nodes removed or axillary lymph node dissection or ≥5 nodes removed. Adherence to lymphedema treatment was assessed by self-report [ 45 , 46 ] and was coded as “yes” if the participant indicated being prescribed and also using one or more of the following treatments at least 25% of the time during the past 3 months: self-care techniques, therapist care, compression garments, bandaging, elevation, skin care, taping, medications, or any other lymphedema treatment in the past 3 months. This variable was coded as “no” if the participant had not been prescribed any of the aforementioned forms of care in the past 3 months or used them less than 25% of the time in the past 3 months.…”

“…Multivariable linear regression models were constructed with an outcome of percent change in continuous interlimb volume difference, as a measure of BCRL severity. Models including a covariate for hand dominance [ 45 ] were explored. Statistical significance was assessed at p < 0.05.…”

Effect of lymphedema self-management group-based education compared with social network-based education on quality of life and fear of cancer recurrence in women with breast cancer: a randomized controlled clinical trial

“…One of the most common side effects of breast cancer is lymphedema affecting about 40% of the survivors [2]. Lymphedema is the chronic and progressive accumulation of lymphatic fluid in the arm, breast, or trunk due to the impaired lymphatic circulation [3], and in addition to disfigurement, it is associated with disorders in psychosocial adaptation, functional status, quality of life (QoL), as well as economic problems [4,5]. A systematic review showed reduced QoL as a result of decreased physical and psychological function and social well-being in women with lymphedema [6].…”

Development and validation of the Lymphedema Symptom and Intensity Survey-Arm

“…There are few comprehensive, valid, and reliable instruments available for use by researchers or clinicians as lymphedema-related symptom assessment tools. Three instruments, the Lymphedema and Breast Cancer Questionnaire (LBCQ) [1,13], the Norman lymphedema survey (NLS) [14,15], and the Functional Assessment of Cancer Therapy plus 4 (FACT-B+4) [16], are often cited in the literature. Two, the LBCQ and the NLS, have predicted the presence of lymphedema, but none of the three comprehensively address psychological symptoms.…”